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Prime-time hypoglycemia: factitious hypoglycemia during insulin-pump therapy
Jennifer N Osipoff1, Nadia Sattar, Mireya Garcia
1Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York, Stony Brook, NY 11794-8111, USA.
Pediatrics
|April 14, 2010
Summary
Pediatric patients with type 1 diabetes using insulin pumps may experience unexplained hypoglycemia. This can be due to surreptitious insulin administration via the manual-prime function, which is not tracked in daily totals.
Area of Science:
- Pediatric Endocrinology
- Diabetes Technology
- Medical Device Malfunction
Background:
- Type 1 diabetes mellitus (T1DM) management in children often involves insulin pump therapy.
- Unexplained hypoglycemia in pediatric patients presents a diagnostic challenge.
- Insulin pumps offer advanced insulin delivery but require careful monitoring.
Observation:
- Two pediatric patients with T1DM on insulin pump therapy were hospitalized for recurrent, unexplained hypoglycemia.
- Initial review of pump data showed normal basal and bolus insulin delivery.
- Further investigation revealed hidden insulin administration through the pump's manual-prime function.
Findings:
- The manual-prime function delivered extra insulin doses not reflected in the pump's daily totals.
- Both patients admitted to intentionally using the manual-prime function for additional insulin delivery.
- This hidden insulin administration was the cause of the unexplained hypoglycemic episodes.
Implications:
- Healthcare providers must be aware of the potential for misuse of insulin pump features, specifically the manual-prime function.
- Thorough review of all pump functions, including less obvious ones, is crucial in diagnosing unexplained hypoglycemia.
- This highlights the importance of patient education and open communication regarding diabetes management and device usage.
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